title: Incidental focal colorectal ¹⁸F-fluorodeoxyglucose uptake on positron emission tomography/computed tomography.
abstract: OBJECTIVE
  To assess the clinical significance of incidental focal colorectal ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) uptake on ¹⁸F-FDG-positron emission tomography/computed tomography (PET/CT).
  
  
  METHODS
  The records of all the cases which had undergone colonoscopy after PET/CT within a two weeks interval were reviewed. Adenomas were considered advanced when they were villous, ≥ 10 mm in size, or had high-grade dysplasia. Colorectal cancers and advanced adenomas are collectively referred to as advanced colorectal neoplasms. Receiver-operating characteristic curve analysis was used to determine the significant predictive maximum standardized uptake value (SUVmax) cutoff value for advanced colorectal neoplasms and cancer.
  
  
  RESULTS
  Ninety-five colorectal lesions matched the site of incidental focal colorectal ¹⁸F-FDG uptake on PET/CT and 146 did not. Colonoscopy showed advanced colorectal neoplasms corresponding to the site of ¹⁸F-FDG uptake in 49 of the 95 (51.5%) lesions with incidental uptake. Of the lesions without incidental uptake, only 6 of 146 (4.1%) had advanced colorectal neoplasms on colonoscopy, indicating a statistically significant difference between the two groups (P < 0.001). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of incidental focal ¹⁸F-FDG uptake in identifying advanced colorectal neoplasms were 89.1%, 75.3%, 51.6%, 95.9%, and 78.4%, respectively. In detecting only CRC, these values were 89.2%, 69.6%, 34.7%, 97.3%, and 72.6%, respectively. The significant SUVmax cutoff value for advanced colorectal neoplasms (area under the curve 0.755, P < 0.001) was 4.35, with a sensitivity, specificity, PPV, NPV, and accuracy of 75.5%, 65.2%, 69.8%, 71.4% and 70.5%, respectively. For CRC, 5.05 was the significant SUVmax cutoff value (area under the curve 0.817, P < 0.001), with a sensitivity, specificity, PPV, NPV, and accuracy of 84.8%, 71.0%, 80.9%, 89.8%, and 75.8%, respectively.
  
  
  CONCLUSIONS
  The presence of incidental focal colorectal ¹⁸F-FDG uptake on PET/CT with a SUVmax ≥ 4.35 increases the likelihood of an advanced colorectal neoplasm.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 137-701, South Korea.
authors.forename: Soung Hoon
authors.initials: SH
authors.lastname: Cho
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Kim
authors.forename: Won Chul
authors.initials: WC
authors.lastname: Kim
authors.forename: Jae Myung
authors.initials: JM
authors.lastname: Park
authors.forename: Ie Ryung
authors.initials: IeR
authors.lastname: Yoo
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Seong Taek
authors.initials: ST
authors.lastname: Oh
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Adenomas; Colonoscopy; Colorectal cancer; Computed tomography; Positron emission tomography